Paediatric Periodontitis Flashcards
What are the 2017 World Workshop classifications of periodontal diseases?
- Periodontal health
- Gingivitis: dental biofilm-induced
- Gingival diseases and conditions: non dental-biofilm induced
- Necrotising periodontal diseases
- Periodontitis
- Periodontitis as a manifestation of systemic disease
- Systemic diseases or conditions affecting the periodontal supporting tissues
- Periodontal abscesses and endodontic-periodontal lesions
- Mucogingival deformities and conditions
- Traumatic occlusal forces
- tooth and prosthesis related factors
What pneumonic can be used to remember the classification of periodontal conditions?
please give greg nine percy pigs straight past meal time tonight
What is periodontal health?
A state:
- free from inflammatory periodontal disease
- allows individual to function normally
- attached gingiva with stippling
- triangular papilla
What are the clinical features of a health periodontium in children?
- gingival margin several millimetres coronal to the CEJ
- gingival sulcus 0.5-3mm deep on a fully erupted tooth
Where does the alveolar crest lie in reference to the CEJ in teenagers?
0.4mm-1.9mm apical
What would place a patient in the category of periodontal health with reduced periodontium?
Non-perio patient =
- crown lengthening surgery
- recession
Periodontal patient =
- stable periodontitis
What are the types of gingival conditions that may be seen in children?
- Plaque biofilm-induced gingivitis
- Non dental biofilm-induced gingival conditiond
Explain how plaque biofilm-induced gingivitis can result in false pocketing:
- supragingival plaque accumulates on teeth, an inflammatory cell infiltrate develops in gingival connective tissue
- junctional epithelium becomes disrupted
- allows apical migration of plaque and an increase in gingival sulcus depth
What are examples of non dental biofilm-induced gingival diseases and conditions?
- genetic
- traumatic lesions
- manifestations of systemic disease
- drug induced
- infective
Give examples of genetic causes of non dental biofilm induced gingival disease:
- hereditary fibromatosis (overgrowth of gingival tissue)
- thin gingival biotype
Give examples of traumatic causes of non dental biofilm induced gingival disease:
- thermal damage (eg burns)
- physical damage (eg toothbrushing, gingivitis artefacta)
Give examples of systemic disease causes of non dental biofilm induced gingival disease:
- haematological conditions (eg lymphoma/leukaemia)
- granulomatous inflammation (crohn’s, sarcoidosis)
- immunological conditions (lichen planus, hypersensitivity reactions)
Give examples of drug-induced causes of non dental biofilm induced gingival disease:
- lichenoid drug reactions
- cytotoxic drugs (methotrexate, hydroxychloroquine)
- calcium channel blockers (nifedipine)
- anticonvulsants (phenytoin)
- immunosuppresants (cyclosporine)
What are the risk factor aetiological aspects of necrotising gingivitis?
- socioeconomic factors (developing countries or poverty)
- smoking
- immunosuppression
- stress
- malcourishment
- poor diet
What are the local factor aetiological aspects of necrotising gingivitis?
- root proximity
- tooth malposition
What are the systemic aetiological aspects of necrotising gingivitis?
HIV positive status
What are tooth anatomical plaque retentive factors that you may see?
- talon cusp
- cingulum
- enamel pearl
- enamel defects
What can cause gingival overgrowth?
- hereditary gingival fibromatosis
- cyclosporine
- phenytoin
- nifedipine
- puberty
How should patients with gingival overgrowth be managed?
- rigorous home care
- frequent PMPR
- +/- surgery if severe (especially for drug induced pts)
When might you consider an urgent referral to a physician after a periodontal screen?
Unexplained:
- gingival enlargment
- inflammation
- bleeding
- mobility
That is INCONSISTENT with the level of OH observed
What are the four main distinguishing features of periodontitis?
- apical migration of junctional epithelium beyond CEJ
- loss of attachment of periodontal tissues to cementum
- transformation of junctional epithelium to pocket epithelium (thin and ulcerated)
- alveolar bone loss
What is considered an early sign of periodontitis in teenagers?
> 1mm loss of attachment
What are the features of periodontitis (molar incisor pattern)?
- rapid attachment loss and bone destruction
- patient is otherwise healthy
- onset around puberty
- family history of disease
What systemic diseases may manifest as periodontitis in children?
- papillon-lefevre syndrome (PLS)
- neutropenias
- down syndrome
- ehlers-danlos syndrome
At what age in children should you do a BPE?
7-18 years old
What probe is used to do a simplified BPE?
WHO 621 probe
- single black band
On which teeth is a simplified BPE carried out?
16, 11, 26, 36, 31, 46
(starts at 7y/o)
What can be used to assess a patients OH levels?
SDCEP Plaque Scores
What are the different plaque scores based on SDCEP guidance?
10/10 = perfectly clean tooth
8/10 = line of plaque around cervical margin
6/10 = cervical 1/3 or crown covered
4/10 = middle 1/3 of crown covered
From what age can you perform a full BPE?
12+ onwards usually
